The fingernail police!!

BHolliRNMS · Jul 13, 2004

Long nails also subject patients to skin tears and scratches when performing procedures. Outlawed where I work. Do what you please on your days off, but when you come to work, have clean short nails, minimum jewelry...oh, and lay off the brow rings, nose rings, lip rings, tongue rings, etc. And pull your hair up! lol

BabyRN2Be · Jul 13, 2004

At our hospital, nails longer than the pad of the finger are not allowed. This is for all employees working in NICU, L&D and P&P. This not only goes for acrylic nails but for natural nails as well. I'm not sure about other parts of the hospital, but this came across specifically for those who work with babies in any way.

RN2B2009 · Jul 13, 2004

There is a student thread floating around about "What You'd Give Up To Be A Nurse". Even though I went to aethetics academy, owned my own business, made women's nails beautiful for 6 years and wore gel nails myself for just as long ... I would give them up in heartbeat!

Nursing is all about the patient, not about how good I look doing it (course, I'm not there yet ... but I've already cut my nails in anticipation!). I'm seriously shocked that this is even an issue for some ...

pickledpepperRN · Jul 13, 2004

Sometimes my nails look good, sometimes one or more breaks off very short. I would not want to worry that I might spread an infection to a patient.

I do know a nurse who scratched the itchy sunburn in her center part. She was off for many weeks with a MRSA infection of the scalp!

http://www.aorn.org/journal/2000/Aug2krc.htm

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5116a1.htm

CDC: Guideline for Hand Hygiene in Health-Care Settings

Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force

Alcohol-based hand rub. An alcohol-containing preparation designed for application to the hands for reducing the number of viable microorganisms on the hands. In the United States, such preparations usually contain 60%--95% ethanol or isopropanol.

Antimicrobial soap. Soap (i.e., detergent) containing an antiseptic agent.

Antiseptic agent. Antimicrobial substances that are applied to the skin to reduce the number of microbial flora. Examples include alcohols, chlorhexidine, chlorine, hexachlorophene, iodine, chloroxylenol (PCMX), quaternary ammonium compounds, and triclosan.

Antiseptic handwash. Washing hands with water and soap or other detergents containing an antiseptic agent.

Antiseptic hand rub. Applying an antiseptic hand-rub product to all surfaces of the hands to reduce the number of microorganisms present.

Cumulative effect. A progressive decrease in the numbers of microorganisms recovered after repeated applications of a test material.

Decontaminate hands. To Reduce bacterial counts on hands by performing antiseptic hand rub or antiseptic handwash.

Detergent. Detergents (i.e., surfactants) are compounds that possess a cleaning action. They are composed of both hydrophilic and lipophilic parts and can be divided into four groups: anionic, cationic, amphoteric, and nonionic detergents. Although products used for handwashing or antiseptic handwash in health-care settings represent various types of detergents, the term "soap" is used to refer to such detergents in this guideline.

Hand antisepsis. Refers to either antiseptic handwash or antiseptic hand rub.

Hand hygiene. A general term that applies to either handwashing, antiseptic handwash, antiseptic hand rub, or surgical hand antisepsis.

Handwashing. Washing hands with plain (i.e., non-antimicrobial) soap and water.

Persistent activity. Persistent activity is defined as the prolonged or extended antimicrobial activity that prevents or inhibits the proliferation or survival of microorganisms after application of the product. This activity may be demonstrated by sampling a site several minutes or hours after application and demonstrating bacterial antimicrobial effectiveness when compared with a baseline level. This property also has been referred to as "residual activity." Both substantive and nonsubstantive active ingredients can show a persistent effect if they substantially lower the number of bacteria during the wash period.

Plain soap. Plain soap refers to detergents that do not contain antimicrobial agents or contain low concentrations of antimicrobial agents that are effective solely as preservatives.

Substantivity. Substantivity is an attribute of certain active ingredients that adhere to the stratum corneum (i.e., remain on the skin after rinsing or drying) to provide an inhibitory effect on the growth of bacteria remaining on the skin.

Surgical hand antisepsis. Antiseptic handwash or antiseptic hand rub performed preoperatively by surgical personnel to eliminate transient and reduce resident hand flora. Antiseptic detergent preparations often have persistent antimicrobial activity.

Visibly soiled hands. Hands showing visible dirt or visibly contaminated with proteinaceous material, blood, or other body fluids (e.g., fecal material or urine).

Waterless antiseptic agent. An antiseptic agent that does not require use of exogenous water. After applying such an agent, the hands are rubbed together until the agent has dried.

Outbreak investigations have indicated an association between infections and understaffing or overcrowding; the association was consistently linked with poor adherence to hand hygiene. During an outbreak investigation of risk factors for central venous catheter-associated bloodstream infections (76), after adjustment for confounding factors, the patient-to-nurse ratio remained an independent risk factor for bloodstream infection, indicating that nursing staff reduction below a critical threshold may have contributed to this outbreak by jeopardizing adequate catheter care. The understaffing of nurses can facilitate the spread of MRSA in intensive-care settings (77) through relaxed attention to basic control measures (e.g., hand hygiene). In an outbreak of Enterobacter cloacae in a neonatal intensive-care unit (78), the daily number of hospitalized children was above the maximum capacity of the unit, resulting in an available space per child below current recommendations. In parallel, the number of staff members on duty was substantially less than the number necessitated by the workload, which also resulted in relaxed attention to basic infection-control measures. Adherence to hand-hygiene practices before device contact was only 25% during the workload peak, but increased to 70% after the end of the understaffing and overcrowding period. Surveillance documented that being hospitalized during this period was associated with a fourfold increased risk of acquiring a health-care--associated infection. This study not only demonstrates the association between workload and infections, but it also highlights the intermediate cause of antimicrobial spread: poor adherence to hand-hygiene policies.

Factors that may influence hand hygiene include those identified in epidemiologic studies and factors reported by HCWs as being reasons for lack of adherence to hand-hygiene recommendations. Risk factors for poor adherence to hand hygiene have been determined objectively in several observational studies or interventions to improve adherence. Among these, being a physician or a nursing assistant, rather than a nurse, was consistently associated with reduced adherence

Fingernails and Artificial Nails

Studies have documented that subungual areas of the hand harbor high concentrations of bacteria, most frequently coagulase-negative staphylococci, gram-negative rods (including Pseudomonas spp.), Corynebacteria, and yeasts (14,342,343). Freshly applied nail polish does not increase the number of bacteria recovered from periungual skin, but chipped nail polish may support the growth of larger numbers of organisms on fingernails (344,345). Even after careful handwashing or the use of surgical scrubs, personnel often harbor substantial numbers of potential pathogens in the subungual spaces (346--348).

Whether artificial nails contribute to transmission of health-care--associated infections is unknown. However, HCWs who wear artificial nails are more likely to harbor gram-negative pathogens on their fingertips than are those who have natural nails, both before and after handwashing (347--349).

Whether the length of natural or artificial nails is a substantial risk factor is unknown, because the majority of bacterial growth occurs along the proximal 1 mm of the nail adjacent to subungual skin (345,347,348). Recently, an outbreak of P. aeruginosa in a neonatal intensive care unit was attributed to two nurses (one with long natural nails and one with long artificial nails) who carried the implicated strains of Pseudomonas spp. on their hands (350).

Patients were substantially more likely than controls to have been cared for by the two nurses during the exposure period, indicating that colonization of long or artificial nails with Pseudomonas spp. may have contributed to causing the outbreak.

Personnel wearing artificial nails also have been epidemiologically implicated in several other outbreaks of infection caused by gram-negative bacilli and yeast (351--353). Although these studies provide evidence that wearing artificial nails poses an infection hazard, additional studies are warranted.

NannaNurse · Jul 13, 2004

We have some nurses/techs where I work that still have the fake nails, even tho' notices have been posted for over a year now. No 'nail' police as yet. Some of you already know my situation....unit currently looking for yet another manager/director since May, so no 'Mom' on the unit to 'police' the area.

It is not just a 'patient' thing here, this is a new regulation handed down from OSHA and JCAHO. Why would you want to bring home all the potential 'bugs' to you and your family?? Gloves or no gloves, germs can get into those small tiny spots and stay there. What if you got an infection between the fake nail and your nail..............uuurrggghhhh!! I can't imagine how disgusting that would be!!!

Think about the patients too. Some of them have skin that is paper thin and you could really 'slice' them up!

I think the fake nails, when kept up, are pretty......but not on a nurse/tech in direct patient care.

The ones where I work are directly defying the regs......it wouldn't bother me to start handing out fines!!

suzanne4, RN · Jul 13, 2004

The fingernail police have not been doing their job by the looks of things. This has been a JACHO ruling for several years. :uhoh21:

Home Health Columnist / Guide · Jul 13, 2004

see the [color=#0b3d91]review of the scientific data regarding hand hygiene from the centers for disease control (cdc):

guideline for hand hygiene in health-care settings

movealong · Jul 13, 2004

I keep my nails neat, but on the shorter side.

Fake nails or real nails, either way, when they are long, I think they pose a problem. I always wondered how some nurses could work in gloves without the nails puncturing the ends of the gloves. I've seen it happen.

Not only did I want to stop the spread of infection in a hospital, but I also don't want to bring any organisms home.

boggle, ASN, RN · Jul 13, 2004

I keep my nails neat, but on the shorter side.
Fake nails or real nails, either way, when they are long, I think they pose a problem. I always wondered how some nurses could work in gloves without the nails puncturing the ends of the gloves. I've seen it happen.

My thoughts exactly. In my first semester of nursing school, when I first learned about rectal suppositories, my long nails became history. And that was even before the class about disimpaction! :eek:

Seriously, our hands are our on the job tools. I have to have the right tools if I'm giving patient care.

*RN123ABC* · Jul 13, 2004

I'm suprised to hear it is a Joint Commission issue, b/c it has never come up anywhere I have worked in NC, TN or MI. I have short nails, but I' d have manicures and wraps or what have you if I could afford it! :chuckle I am among one of the very few where I work that doesn't have long acrylic nails. If a pt's family tried to refuse the care of a nurse w/ long nails, I'm pretty sure they would have to transfer the patient to antoher hospital. I can't think of anyone in my unit besides me and the unit manager who don't have them, and she doesn't give pt care and I don't work extra. They would pretty much be out of luck on that score.

husker-nurse, LPN, LVN · Jul 13, 2004

We are not allowed to have nails longer than 1/8 inch when viewed from the palm-side of the hand. I do not argue with that one. Ya have to wonder what's under the nails of some of that polish! (Think aseptic technique?) Just my opinion! By the way, I work on med-nephro...

Farkinott, RN · Jul 13, 2004

Maybe the booger picking thread should unite with the fingernail one! What a hoot!

Then again you shouldn't pick your nose in case your head caves in!